Transplacental passage of nirmatrelvir in pregnant women with COVID-19

The transplacental passage of nirmatrelvir in pregnant women with COVID‐19 is limited and reinforces the safety of using Paxlovid in pregnancy.

Clinical outcomes of nirmatrelvir-ritonavir use in pregnant women during the Omicron wave of the coronavirus disease 2019 pandemic

BACKGROUND

Paxlovid is an oral drug composed of nirmatrelvir and ritonavir that has been demonstrated to be effective in decreasing the risk of severe coronavirus disease 2019 (COVID-19). Here, we report the use of paxlovid in pregnant women with COVID-19.

METHODS

Pregnant women attending a tertiary referral hospital in Taiwan from 29 April to 30 July 2022 were enrolled in the study. We compared baseline characteristics, clinical manifestations, and adverse events between paxlovid-treated women and those without paxlovid use. Maternal and neonatal outcomes were analysed in women who delivered during the study period.

RESULTS

A total of 30 paxlovid-treated pregnant women and 55 women without paxlovid use were included in the analysis. The mean duration of COVID-19-associated symptoms in the paxlovid-treated women was shorter than that in the control group (10.10 days versus 15.59 days, p = 0.04). No severe adverse events due to paxlovid use were observed. Dysgeusia and diarrhoea were the most common adverse effects. Thirteen paxlovid-treated and 28 untreated women delivered during the study period. More pregnant women in the paxlovid group who delivered during the study period underwent caesarean delivery compared to the group without antiviral treatment (10 of 13 [76.92%] versus 12 of 28 [42.86%], p = 0.042), and insignificantly more newborns were born small for gestational age in the paxlovid group compared to the control group (3 of 13 [23.08%] versus 1 of 28 [3.57%], p = 0.086).

CONCLUSION

Our study showed that paxlovid was effective and safe for pregnant women during the Omicron wave of the COVID-19 pandemic. A higher proportion of caesarean delivery rates was observed among paxlovid-treated women. Long-term follow-up of pregnant women exposed to paxlovid and their offspring is needed.

Setting up a specialized maternity unit in a tertiary hospital: An oasis for pregnant women with COVID-19 during the pandemic

OBJECTIVE

The COVID-19 pandemic has had an enormous impact on society and the medical environment in Taiwan in 2022. As pregnant women with COVID-19 are at higher risk for multiple complications, Taiwan needs a COVID-19 specialized maternity unit to improve the quality of maternal and neonatal care.

MATERIALS AND METHODS

We share our experience with specialized maternity unit for pregnant women with COVID-19 at the National Cheng Kung University Hospital, where we can have careful evaluation, safe birth, and comprehensive postpartum care.

RESULTS

Our COVID-19 specialized maternity unit enrolled 253 pregnant women with COVID-19, 90 (35.6%) pregnant women were admitted to the specialized maternity unit, and 71 (28.1%) pregnant women gave birth during hospitalization in two months. All pregnant women recovery well and real-time polymerase chain reaction tests on all infants were negative for COVID-19.

CONCLUSION

A specialized maternity unit can provide pregnant women with a safe birth environment, immediate maternity care, and high medical quality. It can also help health workers in non-specialized maternity units deal with COVID-19-related psychological stress. Therefore, setting up one specialized maternity unit in the city during the pandemic should be guardedly considered.

Hemolytic disease of the fetus and newborn caused by irregular antibody: A mortality case report and case series during the past 15 years in NCKUH

OBJECTIVE

Hemolytic disease of the fetus and newborn (HDFN) caused by irregular antibodies is a rare, but possibly life-threatening condition. We report a case of severe intrauterine hemolysis caused by anti-E alloimmunization, and review 16 cases in the past 15 years of our hospital.

CASE REPORT

A woman with gestational age 28 weeks and 5 days, received emergent Cesarean section because of fetal distress. The baby was expired at the next day after delivery and the comprehensive study showed severe anemia and alloimmunization related hemolysis caused by anti-E due to high antibody titer (1: 4096).

CONCLUSION

Anti-E antibody is one of the most common non-Rhesus D antibodies in the pathogenesis of HDFN, but rarely leads to severe hemolysis. However, our case has the highest reported anti-E titer in HDFN and is the first case of mortality during the past 15 years in NCKUH.

Interspecies protein-protein interaction network construction for characterization of host-pathogen interactions: a Candida albicans-zebrafish interaction study

Background

Despite clinical research and development in the last decades, infectious diseases remain a top global problem in public health today, being responsible for millions of morbidities and mortalities each year. Therefore, many studies have sought to investigate host-pathogen interactions from various viewpoints in attempts to understand pathogenic and defensive mechanisms, which could help control pathogenic infections. However, most of these efforts have focused predominately on the host or the pathogen individually rather than on a simultaneous analysis of both interaction partners.

Results

In this study, with the help of simultaneously quantified time-course Candida albicans-zebrafish interaction transcriptomics and other omics data, a computational framework was developed to construct the interspecies protein-protein interaction (PPI) network for C. albicans-zebrafish interactions based on the inference of ortholog-based PPIs and the dynamic modeling of regulatory responses. The identified C. albicans-zebrafish interspecies PPI network highlights the association between C. albicans pathogenesis and the zebrafish redox process, indicating that redox status is critical in the battle between the host and pathogen.

Conclusions

Advancing from the single-species network construction method, the interspecies network construction approach allows further characterization and elucidation of the host-pathogen interactions. With continued accumulation of interspecies transcriptomics data, the proposed method could be used to explore progressive network rewiring over time, which could benefit the development of network medicine for infectious diseases.

Ischemic bowel secondary to angiocentric T-cell lymphoma of intestine: a case report

A case of intestinal angiocentric T-cell lymphoma is reported, occurring in a 72-year-old female who had suffered from poor appetite, body weight loss and abdominal pain for two months. Plain abdominal film revealed ileus, and she received laparotomy under the impression of ischemic bowel. Surprisingly, pathologic examination disclosed an angiocentric T-cell lymphoma of jejunum complicated with focal intestinal necrosis. This case emphasizes the angiocentric and angioinvasive character of some T-cell lymphomas. Angiocentric T-cell lymphoma must be considered as a possible cause of ischemic bowel.

Psoas abscess due to mucinous cystadenocarcinoma of the appendix: a case report

Psoas muscle abscess is an uncommon and challenging entity. The present report describes a 64-year-old man presenting with right flank mass. Abdominal computerized tomography showed a right psoas abscess. Extraperitoneal drainage was performed, and pathology revealed metastatic mucinous adenocarcinoma. After further study, laparotomy and right hemicolectomy were performed under the impression of colon cancer. The final pathology showed mucinous cystadenocarcinoma of appendix. The literature about the etiology, diagnosis and treatment of psoas abscess are reviewed. Additionally, the treatment and prognosis for mucinous cystadenocarcinoma of the appendix are noted.

Evidence for accessory cell function by class II MHC antigen-expressing airway epithelial cells

Expression of major histocompatibility complex (MHC) class II antigens is a requirement for accessory cell function in antigen presentation. Recent reports have demonstrated the presence of class II antigens on human bronchial epithelial cells. In the present study, immunohistochemical staining revealed HLA-DR on human airway epithelial cells obtained from two different mucosal sites (lobar bronchus and nasal turbinates). To determine whether airway epithelial cells bear functional class II molecules that allow for their cognate interaction with T lymphocytes, cells isolated from these sites were used in mixed lymphocyte cultures (MLR), as an in vitro model of accessory cell function. Freshly isolated cells (11 bronchi/3 turbinates) stimulated allogeneic T lymphocytes (stimulation index [S.I.] = 9.3 [mean]; P less than 0.001 compared to T cells alone). In order to assess the potential role of contaminating conventional accessory cells, bronchial epithelial cell isolates were first preincubated in a serum-free, growth factor-supplemented medium that functionally eliminates potential non-epithelial stimulators prior to MLR culture. Conventional accessory cell-depleted epithelial cells were still capable of stimulating allogenic T lymphocytes in 18 of 23 MLR cultures (S.I. = 5.5 [mean]; P less than 0.0005 compared to T cells alone). The addition of an anti-class II monoclonal antibody (VG2.2) at the onset of culture completely inhibited the MLR response (n = 10). No shift in the CD4+/CD8+ ratio was detected between lymphocytes harvested from airway epithelial cell MLR (1.42 +/- 1.29) and the ratio from T lymphocytes cultured alone (1.3 +/- 0.75), suggesting that both CD4+ and CD8+ T lymphocytes were proliferating in response to stimulation from alloepitopes recognized on airway epithelial cells.(ABSTRACT TRUNCATED AT 250 WORDS)

Pulmonary infection with Mycobacterium avium-intracellulare: diagnosis, clinical patterns, treatment

Most physicians fail to recognize Mycobacterium avium-intracellulare (MAI) as a major pathogen for pulmonary disease among patients admitted to hospitals throughout the United States. In a review of all records of positive MAI cultures during the 10 years beginning July 1, 1979, at The Mount Sinai Hospital, New York City, we have identified 244 patients who had pulmonary disease primarily or secondarily complicated by MAI. We also identified another 243 patients as false positive for MAI infection. We classed as false positives patients who had no subsequent positive culture and whose clinical picture was and remained incompatible with MAI infection. We identified four distinct clinical patterns in the 244 patients with true positive MAI infections: (a) pulmonary nodules ("tuberculomas") indistinguishable from pulmonary neoplasms (78 patients); (b) chronic bronchitis or bronchiectasis with sputum repeatedly positive for MAI or granulomas on biopsy (58 patients, virtually all older white women); (c) cavitary lung disease and scattered pulmonary nodules mimicking M. tuberculosis infection (12 patients); (d) diffuse pulmonary infiltrations in immunocompromised hosts, primarily patients with AIDS (96 patients). The diagnosis should be established either by surgical resection and culture of resected nodules, or by three repeated positive acid-fast bacillus cultures of sputum or fluid and tissue obtained by bronchoscopy, or by biopsy of other tissue which shows granulomas and one or more positive MAI cultures. Surgical resection is the best treatment for "solitary" MAI nodules. Multiple antituberculous drug therapy is indicated for patients with chronic infection that impairs function or causes hemoptysis. The presence of MAI in the sputum or lung aspirates of patients with AIDS usually heralds the presence of a preterminal disseminated infection.

Bronchoscopy in diffuse lung disease: evaluation by open lung biopsy in nondiagnostic transbronchial lung biopsy

Transbronchial lung biopsy through the flexible bronchoscope is used widely for the diagnosis of diffuse lung disease; however, a significant number of specimens obtained by the bronchoscopic 2-mm biopsy forceps will reveal nonspecific findings, eg, interstitial fibrosis or nonspecific pneumonitis. Such a report may be an accurate reflection of the presence of idiopathic pulmonary fibrosis or nonspecific pneumonitis, but may merely indicate that the true diagnosis has been missed. We retrospectively studied 38 patients with diffuse lung disease whose transbronchial lung biopsies yielded nonspecific abnormalities. Subsequently, these patients were subjected to open lung biopsies. Nineteen of the 38 patients (50%) had a specific diagnosis made by open lung biopsy. The diagnoses included bronchiolitis obliterans, alveolar proteinosis, metastatic carcinoma, lymphoma, tuberculosis, and bronchioloalveolar cell carcinoma. Although transbronchial lung biopsy is useful in the diagnosis of many diffuse lung diseases, it is not a replacement for open lung biopsy. When nonspecific findings by transbronchial lung biopsy do not correlate with the clinical picture, open lung biopsy should be performed.

Flexible bronchoscopy in the diagnosis of Pneumocystis carinii pneumonia in patients with acquired immune deficiency syndrome

Seventy-seven patients with acquired immune deficiency syndrome (AIDS) and suspected of having Pneumocystis carinii pneumonia (PCP) had flexible bronchoscopy. The diagnosis was established in 52 of the 54 patients (96%) who proved to have PCP. There was one false-positive result. The remaining 22 patients and the patient with the false-positive diagnosis had diseases other than PCP, or no diagnosis. Flexible bronchoscopy is a safe and sensitive diagnostic procedure in patients with PCP complicating AIDS, and is recommended as the first invasive diagnostic procedure when patients at risk for AIDS have acute pulmonary complications.

Transcutaneous oxygen monitoring during fiberoptic bronchoscopy

A transcutaneous oxygen sensor was used to detect the development of hypoxemia in patients undergoing fiberoptic bronchoscopy. Measurements of transcutaneous PO2 (tcPO2) correlated well with arterial PO2 (PaO2), and correctly detected all instances when PaO2 was less than 65 mm Hg. The sensor was noninvasive and caused no adverse effects.

Diagnosis of pulmonary complications of the acquired immune deficiency syndrome

Forty eight patients with the acquired immunedeficiency syndrome (AIDS) presented to the Mount Sinai Hospital in New York with persistent cough and dyspnoea or an abnormal chest radiograph, or both. Thirty two (67%) were found to have Pneumocystis carinii pneumonia, either alone or in combination with another pathogen. Of these patients, eight (25%) had a normal chest radiograph. Abnormalities in the single breath carbon monoxide diffusing capacity and alveolar-arterial oxygen gradient [A-a) DO2) suggested infection with Pneumocystis carinii. Fibreoptic bronchoscopy with transbronchial biopsy was 100% sensitive in the diagnosis of pneumocytis pneumonia. Fibreoptic bronchoscopy should be undertaken in patients suspected of having a pulmonary complication of AIDS, even if the chest radiograph is normal.

Diagnosis of lung cancer by fibreoptic bronchoscopy: problems in the histological classification of non-small cell carcinomas

Specific cell typing in lung cancer has important implications for assessment of prognosis and the planning of treatment. Cell typing is, however, often difficult and the problem has been compounded by the universal use of the flexible fibreoptic bronchoscope, which yields specimens only 2 mm in diameter. We have reviewed the records of 107 patients who had a diagnosis of lung cancer established by fibreoptic bronchoscopy and who subsequently underwent staging biopsy or surgical resection. Examination of tissue obtained by surgical resection yielded a different cell type from that identified in specimens obtained at fibreoptic bronchoscopy in 11 of 32 patients with a bronchial biopsy specimen diagnostic of squamous cell, three of 44 patients with a diagnosis of adenocarcinoma, six of seven thought to have a poorly differentiated carcinoma, and 21 of 24 patients with a diagnosis of large cell carcinoma. In all, 41 of the 107 surgically removed specimens (38%) differed in cell type from their corresponding bronchoscopic specimens. Accurate cell typing by specimens obtained at fibreoptic bronchoscopy may be extremely difficult. If clearcut morphological criteria cannot be satisfied, the diagnosis of "lung cancer, non-small cell type" should be made.

Flexible fiberoptic bronchoscopy in metastatic cancer to the lungs

Seventy-eight patients with metastatic cancer to the lungs underwent flexible fiberoptic bronchoscopy for diagnosis. The patients were divided into two groups by presenting radiographic pattern as: (I) diffuse linear interstitial infiltrations (55 patients); and (II) localized or multiple nodular opacities (23 patients). The diagnosis of cancer was established by bronchoscopy in both groups of patients with approximately equal frequency. In Group I, bronchoscopic biopsy results were positive in 34 patients (62%), cytology results were positive in 30 patients (55%), and 42 patients (76%) had a positive biopsy and/or cytology result. In group II, biopsy results were positive in 14 patients (61%), cytology results were positive in 8 patients (35%), and 15 (65%) patients had a positive biopsy and/or cytology result. Patients whose chest radiograph showed atelectasis, suggesting the presence of endobronchial metastases, were excluded from the study. However, endobronchial examination unexpectedly revealed metastatic endobronchial carcinoma in 9 patients, 4 in Group I and 5 in Group II. Fiberoptic bronchoscopy is a relatively simple and direct technique for the histologic diagnosis of metastatic cancer to the lungs. Endobronchial metastases are common, even when not suspected by radiographic examination.

Adenocarcinoma arising in an intrathoracic duplication cyst of foregut origin: a case report with review of the literature

A 41-year-old man presented with an asymptomatic superior mediastinal mass. At thoracotomy, a duplication cyst of the foregut was found. Microscopic examination of the cyst revealed mucosal alterations ranging from dysplasia and in situ carcinoma to infiltrating colonic carcinoma. Although malignant change has been reported in intra-abdominal foregut cysts, this is the first reported instance of carcinoma arising in a mediastinal duplication cyst.

Fiberoptic bronchoscopy in patient with Hodgkin's and non-Hodgkin's lymphomas

Sixty-four fiberoptic bronchoscopic examinations were performed for 58 patients with Hodgkin's and non-Hodgkin's lymphomas and radiographically evident pulmonary abnormalities. Diagnoses were obtained in 23 cases (36%). Examination of 12 lung biopsy specimens showed lymphoma and one, squamous cell carcinoma. Six patients had pneumocystis carinii; 2, aspergillosis; 1 cryptococcosis; and 1, herpes simplex infection. It is recommended that fiberoptic bronchoscopy be the first invasive procedure employed in the evaluation of pulmonary parenchymal abnormalities in patients with Hodgkin's and non-Hodgkin's lymphomas.

Rhizopus lung abscess in renal transplant patient successfully treated by lobectomy

A 46-year-old man with diabetes mellitus and cadaveric kidney transplant, maintained on a regimen of prednisone and azathioprine, developed a necrotizing pneumonia. The abscess cavity became secondarily infected with Rhizopus and was cured by surgical resection. Secondary invasion of an abscess cavity by Rhizopus and the successful surgical treatment of pulmonary phycomycosis in an immunosuppressed patient have not previously been reported.

Clinical validation of automated spirometry used in surveys of large occupational groups: comparison with conventional water spirometry

An accurate, rugged automated spirometer which provides immediate data is useful both clinically and for screening large groups with various environmental exposures. Because the need for such surveys has been increasing, we compared a computerized mass flow-meter with a conventional water spirometer. The same forced expiration was measured by both instruments in the laboratory and during an occupational survey. Mean values for forced vital capacity (FVC) were 96 cc greater by the automated technique in the laboratory (this equals 2.2% of the value by the conventional method, with a correlation, r, of 0.998) and 97 cc greater in the field (2.3% of the conventional method; r = 0.995). Differences between the two methods in the laboratory and field for forced expiratory volume in one second (FEV 1.0) were +24 cc (0.68%; r = 0.996) and +47 cc (1.6%; r = 0.996) and for forced expiratory flow (FEF)25-75--179cc/sec (4.18%; r = 0.968) and -63 cc/sec (2.1%; r = 0.992), respectively. For FVC and FEV1.0, the differences between paired values were less than or equal to 10% of the value by water spirometry in all instances and less than or equal to 5% in 95.5% and 96% of comparisons, respectively. For FEF 25-75 the differences between paired values were less than or equal to 20% in 97.2% and less than or equal to 10% in 84.7% of comparisons. These findings confirm the validity of the measurements provided by the automated spirometer.

Flexible bronchoscopy in nonvisualized carcinoma of the lung

Of 1,000 consecutive patients undergoing fiberoptic bronchoscopy, 331 eventually were proven to have primary lung cancer. Of the 331 carcinomas, 253 were beyond the visual range of the flexible bronchoscope. However, under fluoroscopic guidance, the diagnosis of carcinoma was established in 194 (76.7%) of these nonvisualized tumors. Cytologic analysis of brush specimens was more often positive for malignancy than specimens obtained by forceps biopsy. An expert cytologist and experienced bronchoscopy team are esential for a high percentage of reliable positive diagnoses in bronchogenic carcinoma.